Are you referring to yourself in asking this question or are you talking about someone you personally know?

In the past, has the cutting of his arms been accomplished primarily during periods when he was distressed and when he is faced with having to handle a very difficult, frustrating conflict situation on his own? Or, has he primarily cut himself to get out of doing work, as might be the case in a work environment?

It is a friend of mine - the employer has asserted he burnt his arm (3rd degree) deliberately (in the absence of a mechanical/technical explanation). He denies this. He is an ex-soldier (as am I) who served in the Gulf. In the past self harming has been when depressed/at times of great stress. This accident occured when he was happy and engaged to be married. I just wanted to know if the employer might be right and my faith in him might be misplaced!

The critical thing to try to evaluate is the function of the action, if it was purposeful. In the past, you note that he self-injured when he was depressed and under stress; was this limited to his period in the Gulf, or after he returned home (or both)? Also, what was the outcome of his work-related burn injury? Is he now released from work for a time to recover?

He asserts that the accident was an accident - he always has; he has self harmed before but largely after his tour in the Gulf. The self harming was cutting the upper arm although it seems he once swallowed something. He enjoyed his work. The burn was a significant injury which has left no significant functional disability but a significant scar. The injury was 2 years ago - he was having regualr treatment for 2 months post injury.

Most people who self-injure do so because it helps them regulate aversive emotions. That is, people who cut or purposely burn themselves have never learned healthier ways to cope with terribly painful or aversive emotions. The causes of these emotional problems are being placed in situations in which they feel extreme emotional distress and perceive that they are utterly helpless to change the situation or escape it. Such situations are for example, living in a violent or intensely contentious family circumstance; being physically or sexually abused as a child or adolescent, or any other inescapable, "helpless" situation that involves intense upset, stress and depression.

Research suggests that self-injurers are not intent on committing suicide; self-injury distracts them from feeling badly; it can help change their feeling state if they focus on the cut and blood flow; some report that cutting themselves relieves their feelings of emotional numbness; others find that hurting ones self BEFORE a perpetrator can harm them helps them escape the abuse of a perpetrator because they are 'already injured' and need medical attention. So there are many purposes served by self-injury which may vary a bit from person to person; but emotion regulation is the best general explanation; and the idea that the vast majority of self-injurers have suffered serious trauma or abuse at an earlier stage of their life is significant. People can continue this pattern of behavior into late stages of life if they have not learned how to better identify, express and cope with strong, aversive emotions. usually seeing a good psychologist or other mental health professional who works with family violence or abuse victims, will have a good understanding of this problem. And, a few self-injurers inflict plain on themselves to escape or avoid work (e.g., obtain disability payments), or to obtain the care and attention of employers, health care workers, etc. (this is called Munchausen's syndrome when it becomes extreme)

If in fact, there is no remotely realistic mechanical or technical explanation for an employee being burned like this, then the suspicion that this may be self-inflicted remains reasonably strong, given his prior history. It doesn't matter if this man generally seems happy and is engaged. Self-injury acts are typically related to a localized episode of stress, tension or upset e.g., something can go awry for a short period of the day and the self-injury occurs. And, then, the remainder of the person's week can be relatively peaceful.

If you are a close friend and want to try to be helpful, you can explain that given his history of self-injury, it is only natural for people to be highly suspicious that this was a deliberate act; and if this was the case, it would be helpful for him to understand that employers and health experts will immediately ask the question in the future (if this ever happens again), "what purpose does behavior serve him? What is its function? What outcomes does it produce? Does it help this guy regulate stress and difficult emotions, escape or avoid work, or gain some care and attention? Basically, he needs to hear that if this happens again, he may face dismissal from his job because his employer will probably want to ask you to release all of your military and health records, and then he will immediately view you as a great safety and legal liability to the company.

I hope this answers your question. Please let me know if I have overlooked anything in providing this response.

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